Category: Hair Transplantation

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Proactive Hair Transplants – Hair Loss Information – Balding Blog

My question is perhaps unusual but I feel it is a valid one. I am 33 and I have been experiencing slow diffused thinning over about 7ish years. My thinning started to show in the top of my crown and slowly moved towards the mid and front. I have had no hairline depletion or recession at all.

So I have been on finasteride for about 4 months now. I also had a procedure at another clinic and had a 1.25cm*33cm strip taken and I have high density especially in the back. Anyway, grafting was done basically over the class 6 sort of layout with a back up hairline behind my current one. My total hair count was approx 7,500 hairs. I do have coarse black hair that becomes wavy when long.

Here’s my concern, though I am no where near my final result, what is the merit to doing another say more proactive procedure? That was my original plan but I mean almost in anticipation of the class 6 coming to full reality in my lifetime. Proactive grafting. Thank you in advance, you advice is greatly appreciated.

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Finasteride is the best approach to your future concerns. At only 4 months on the medication, you’re not likely to see much results-wise from it, but stay the course. You could avoid surgery by taking a pill.

I am not an advocate for proactive or preventive hair transplants. My 9 months old granddaughter has a relatively large bald spot on the back of her head. I tease my son about transplanting it, but that is only a joke in a hair transplant family.

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If I Have a Transplant Now, Would That Mean Future Treatments Wouldn’t Work? – Hair Loss Information – Balding Blog

Have had a thinning hairline for the past few years (I’m 27). I take propecia and rogaine to slow it down, but lately it has been getting a bit more noticeable.

I am considering getting a hair transplant, I have a question regarding future treatment though. Lets say I get a hair transplant now and eventually a topical or injectable solution comes out to reverse hairloss. Would there be a conflict between the transplanted follicles, and the follicles in the same area that are miniaturized/dormant that are now being revitalized? Would getting a hair transplant mean I couldn’t use those future treatments?

Thanks.

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We always advocate having a Master Plan made, which means you need a consultation with a doctor.

I do not know the future of hair restoration technology, but a hair transplant surgery would not be a contraindication to any future developments. That is, unless you end up with a bad hair transplant surgery… so choose your doctor wisely.

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Do Hair Transplant Surgeons Take Shock Loss Into Account? – Hair Loss Information – Balding Blog

I wanted to comment and say you have a really informative website and I enjoy reading the blogs on here and your advice to people. I try to come here as much as I can and get advice with my hair loss situation.

My question is regarding thinning hair and transplants. When a surgeon places grafts into a thinning area, does he take into consideration there might be shock loss present and places more grafts into that area to fill it in, even though the patient is on propecia and lets say he’s 30 yrs of age? Or, does he expect the patient to come back for future surgeries to fill in the thinning area due to shock loss?

My other question is regarding working out and losing hair. I mostly run to stay in shape and stay away from the heavy lifting. I have read on this website, that working out with either weights or running doesn’t increase hair loss. However, I have read some comments from posters also on here that it has made them lose hair, and I have heard from other people at the gym where I live that they noticed hair loss while working out, without steroids of course, or while taking creatine (supplement). So, Which is the truth?

Thank you for helping me.

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When transplanting hair into a young man (under 30 years old), shock hair loss should be at the top of the discussion points, particularly if the young man does not take finasteride. Of course, the same is true for patients older than 30. Where the cut off is for risk of shock hair loss without finasteride on board, I am not quite sure… but I know it happens even to a 40 year old and an occasional 50 year old. Being on finasteride, having a small number of grafts (no mega sessions), and not having any accelerated thinning definitely is a good indicator. In the end it is really about each patient on a case by case basis. There is no set rule. Thus relationship with a doctor is very important.

Transplanting into thinning hair follows the same rules as above, but there is not the introduction of mechanical shock into thinning, miniaturized hair, which is more susceptible for hair loss than normal hair that is not miniaturized.

As for exercise and heavy lifting, as long as you stay away from anabolic steroids, I do not believe there is risk with protein concoctions. Hair loss has been reported in rare cases while taking creatine, but I can’t say for sure if there is truth to it.

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I Have Obvious Hair Plugs and Now I Just Want to Be Naturally Bald – Hair Loss Information – Balding Blog

Dear Dr. Rassman:

I am a 45 year old male with obvious hair plugs. I had two sessions done back in 1993. In considering all of my repair options, I would like to just be naturally bald. I wonder the hair transplanted can be removed. I am not interested in additional grafting. I like to be bald. Thank you.

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Shaving your head will probably bring out the pitting in the recipient area that often accompanies the old style of hair plugs. We have developed a process call Scalp MicroPigmentation (SMP), which works well when the hair is clipped very short to make you look like a normal fellow with a shaved head. The pitting I mentioned is often hidden by this process, but I would have to see you to tell you what can be done.

Here’s an example of a patient that had SMP done to hide his plug scars in the donor area. The photo was taken immediately after one session.

 

If you are not in California, send some good photos with multiple angles to the email address on the Contact page and I will try to give you an opinion over the phone.

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Hair Loss InformationI Had Multiple Hair Transplants and the Hair Fell Out After 5 Years – Hair Loss Information – Balding Blog

Had my first transplant (flap rotation) at age 19 in 1985 (big mistake). Continued to bald behind flap and put up with stares from strangers until 2005 when had 3000 fue put in front and behind flap. Grew out well, no stares, felt pretty normal, life was great.

Problem April 2010, nearly all 3000 fue fell out after 5 years of growing, all in about a 6 month period. Back to being stared at. September 2010 had another 3000 fue (2000 scalp 1000 beard) put in front and behind flap by same reputable FUE surgeon. Grew out well again, but now starting to fall out and started getting stared at again.

Had blood work done but all clear for thyroid, lupus, iron etc. Have used 2.5mg Proscar for many years and not changed regime. Not on any medications known to cause hair loss. Getting very desperate as no donor left for more transplants. Any ideas on what could be going on ? Any advice much appreciated. Thanks.

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There is clearly something going on and you need to address your issues with your surgeon.

I sound like I’m a broken record, but body hair / beard hair does not follow the same growth cycle as scalp hair and it is not considered the standard in hair transplant surgery. I have seen many failures of body hair transplant patients performed by doctors all over the world.

Some surgeons use grafts from outside of the donor area, and FUE grafts taken from the non-permanent areas can fall out, as this may be genetically triggered and accelerated. For clarity, the permanent zone is 2 1/2 inches high and can be measured above the notch on the back of the skull and around the sides of the head.

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Hair Loss InformationMy Hair Transplant Looked Great at 5 Months, Not As Great at 8 Months Post-Operative – Hair Loss Information – Balding Blog

My question is regarding post operative transplant shedding. For a little background, I’m a 26 year old male on Propecia for 2 years and exactly 8 months out of a 2000 graft hair transplant all in the frontal part of the scalp. At 5 months, my results were excellent, a very dense, even result with a natural looking appearance and texture. Since that time, however, I have noticed an increased thinning in my hairline; leaving a more see-through appearance. This has been coupled with a more “pluggy” texture. Furthermore, at 6 months, I noticed an increase in shedding but it has slowed down in the last 6 weeks.

My 8 month result is still great but there’s a visible difference in the last three months. Is this merely a part of the natural process for some patients and can’t be judge too quickly in my first year growth? Any help would be greatly appreciated! Also, let me know if you need extra information to answer my question.

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Why don’t you follow up with your doctor with these issues? A pluggy texture is not good. Thinning may be related to continued (normal) genetic hair loss that may have happened without surgery. Shock loss is generally seen in the first month or two after the surgery.

In general, results of a hair transplant surgery can be seen in as early as the 2nd month all the way up to 12 months. Most see results in about 6-8 months. I couldn’t tell you why your results looked better at 5 months than they do at 8 months, though.

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Hair Loss InformationPatients That Opt for a Transplant That Still Shows Hairline Recession? – Hair Loss Information – Balding Blog

Hey doc, I noticed your blog here presents us with numerous demonstrations of surgeries, where a receding hair line is being restored to a full-blown NW1. However, the impact of surgery on donor area (whether FUT or FUE) has drawn me to weigh the benefits of smaller improvements.

But I don’t remember seeing here any pictures of patients who could easily (graft-wise) afford a Norwood 1 transformation, but have chosen a minimalistic path (for example, going from a Norwood 3 to a 2 or simply increasing the width of the forelock a bit to eliminate the steepness of its shape). Such visual representations will surely educate us about our options with surgery.

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I’m sure we’ve posted examples of patients that didn’t want a fully restored hairline on this site in the past, and I know there have been plenty of men who have had surgery for a “minimalistic” path. A patient must give us permission before publishing their pictures, so we’re only able to post those that have given their consent. Not every patient wants their photos shown to others.

There are comprehensive before / after pictures in our NHI photo galleries that will show various examples of hairline restoration.

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FUE: More Automation and Physician Integrity (Part 4 of 4) – Hair Loss Information – Balding Blog

This is the last part in the series about follicular unit extraction (FUE). Here are the previous posts in this series — part 1, part 2, and part 3.

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Neograft:

We have heard a great deal about the Neograft automated system. This system has two components to it:

  1. A sharp drill that provides controlled torque. It is a manual system requiring a very skilled operator.
  2. An implanter is part of the Neograft system and it uses an implanter invented by Rassman (patent #8062322) that works nicely.

The advantage of the Neograft system is that an implanter is offered, which is not present in the ARTAS system. Traditional implantation with forceps requires specialized skills and the greatest cause for failure or death of the grafts occurs during the implantation process. The neograft implanter, can be used effectively by an inexperienced person, therefore it is relatively easier to learn when compared against the use of forceps. The inexperienced surgeon or technician will probably get better graft survival with the implanter. When compared with a skilled experienced technician’s competence with forceps, I suspect that the two techniques will be comparable.

The manual drill requires expertise, and with the unit as designed the grafts have a tendency to dry out, possibly killing them before they get implanted as they are held in a chamber that has a high hair movement in it. As discussed before, air kills grafts as they dry and this killing process may take only seconds when there is substantial air flow in graft held in a chamber. Neograft associates with a private group of technicians that perform much of the procedure for the unskilled doctor, creating the illusion that the doctor is skilled in the process. If these technicians drill out the follicular unit, they will violate the laws in most states. Most doctors who use the Neograft system depend upon the technician teams to do the actual transplant procedure.

Other drills are supplied by a variety of device manufacturers. Dr. Harris employs a dull drill and his device is amongst the most popular of the devices that are manually driven with great success. He offers training for doctors who purchase his system. Drills with sharp edges are many and they differ only marginally from each other. Extraction speed varies with each surgeon and each instrument. There is no substitute for skill, and the skills for all instruments on the market (other than the ARTAS system) requires possibly years to perfect. Speed of extraction depends upon the surgeon’s skills and it varies between 200-1200/grafts per hour on average. The damage to the grafts varies with the surgeon, so speed tells you little about the skills of the doctor as some doctors kill more than 50% of the grafts in the extraction process.

Technology vs Skill:

The New Hair Institute uses a specially designed serrated system that is not connected to a drill. This instrument was designed by Dr. Pak and it is made by a machine shop that specializes in fine stainless steel instruments. We have gotten good value with this tool, pacing ourselves at over 1000 grafts per hour and producing little damage. Our speed of extraction in 80% of patients, exceeds the speed of almost all other such extraction tools in our hands.

All too often, patients focus on the technology, not the skill of the surgeon. Only the ARTAS system does not require surgeon skills as the robot cores out the hair grafts with minimal involvement by the surgeon as the robot does it all once it is set up. The ARTAS system does require manual graft removal and the difficult job of graft placement must be done by people with extensive experience in the field using forceps or possibly an automated commercial system called the Choi Implanter. Generally, it takes between 1-3 years to develop placing techniques that allow speed and minimize damage to the grafts.

I can not end this story without discussing the integrity of the doctor. Doctors tell you what they want you to hear — that they are the best at FUE, that they get less than 2% transection rates, that their vast experience makes them better than everyone else. Can you or should you believe what the doctor is telling you? I know for certain that many doctors claim expertise in FUE, promise minimal damage to the grafts, or even close to 100% growth rates, etc. The reality is that every patient getting FUE differs in their results and we published these differences in patient dynamics in a medical journal publication, which is the only such formal publication out there. I have seen some awful results with FUE and failures close to 90% in some patient. The proclamation of the doctor’s skills by the doctor is a reflection of their integrity. There is an old adage that if it sounds too good to be true, it is.

So in conclusion — be skeptical, use your skills in evaluating your doctor’s integrity as your guide as to what you can believe and what you can not believe. I look forward to comments from our readership.

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If I Want to Have a Very Short Hair Style Forever, Can I Use BHT? – Hair Loss Information – Balding Blog

Happy New Yr Mr. Rassman.

Currently, I shave my sides with a trimmer to 0.25 number and keep the little existing hair on my scalp shaved at 0.5 number. This is because I dont have hair to show off anyways, so might as well give it a shaved look. Even though I have some donor area, I am sure it wont be enough for hair transplant to give it a long full hair appearance.

As an alternative, I would like to have a shaved look but without SMP / using chemicals. I would like to achieve this with BHT but I do see from your previous posts that you are not a big fan of BHT because of the different texture and the growth rate of hair.

So my idea is to use the body hair on the the top of the scalp. It may not grow in the same pace / texture with the rest of the existing hair but what if I want to keep shaving it (or trimming to 0.5 number). Will it help? My logic says if I am shaving it / trimming it, it would probably.

My concern is:
1) ARE THERE ever SCARS in the recipient area? This question is relevant here because I will be shaving / keeping my scalp hair very short (0.25 or 0.5 number on the trimmer)

2) In your experience, while transplanting hair (whether hair from back of the head or body hair) into the recipient area, can existing hair get damaged?

Thanks for all your good work, may the force be with you.

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I will be direct to your questions.

1) Visible recipient site scars are rare if the instrument is very small and a slit is used. But with any surgery, there is a small (rare) risk of keloid and scarring.

2) Existing hair is rarely damaged, unless perhaps there is shock loss, which is typical of young men under the age of 30 who do not take the drug finasteride. (This is not an absolute rule as some men decline to take finasteride. It is a case by case basis.) In general, the younger they are, the greater the risk of shock loss.

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Hair Loss InformationHow Long Until I Can Use a Sauna After a Hair Transplant? – Hair Loss Information – Balding Blog

Hi doctors,
How long after a hair transplant until I can use a steam room / sauna? And how about a tanning salon? Thanks

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You should address any post operative questions with your doctor, as each doctor has their own recommendations. In general, most patients can resume normal activities in two to three weeks after a hair transplant surgery — including a sauna.

Tanning salons are not generally recommended for health benefits and high dose UV rays can potentially discolor skin during the healing process, which can take up to 6 months. This does not mean you have to keep out of the sun, just use a sun blocker.